This slide demonstrates the interrelationships between insulin resistance, diabetes and cardiovascular disease. It is proposed that the primary disorder is insulin resistance, wherein the insulin hormone does not act properly at its target tissues, notably the liver, muscle and fat cells. This leads to an increase in the blood sugar and hyperinsulinemia or high insulin levels in the blood. The generation of these high levels is thought to lead to b cell exhaustion such that eventually the b cells that produce insulin fail to do so leading to inadequate or hypoinsulinemia and frank diabetes. The high blood sugar itself may also lead to toxicity or damage the b cells and hasten the onset of decreased insulin production. Insulin resistance also leads to a disturbance of virtually all the regular cardiovascular risk factors, blood pressure and lipoproteins in particular, which will increase atherosclerosis. High insulin levels seen in insulin resistance may also directly promote the development of atherosclerosis, although this is controversial. Diabetes also leads to other derangments which also increase atherosclerosis.